The National Databank for Rheumatic Disease (NDR) in the United States was used to examine the risk of mortality among RA patients over time based on disease duration and choice of treatment. Non-inflammatory and RA patients were studied from 1998-2011 in all 50 states. Among the 15,791 RA patients enrolled, 3,531 died during this period.
The hazard ratio (HR) for mortality in RA vs non-inflammatory patients was 1.4 adjusting for age and sex. Adjusting for additional confounders such as marital status, being employed, BMI and smoking, resulted in a HR of 1.35. The promising aspect is that this ratio has decreased over the last 14 years, where the HR was 1.74 before 2004 and 1.56 before 2008.
In RA patients, increased mortality was associated with markers of worse disease activity, smoking, being married and being underweight. The use of cytotoxic DMARDs and no DMARDs were both associated with greater risk compared to methotrexate monotherapy. The surprising finding, unlike other studies, was that the rate of mortality showed no difference between methotrexate monotherapy and biologic treatment after adjusting for multiple confounders.
Carolyn Whiskin, BSc. Phm is currently the director of pharmacy programs for the Charlton Centre for Specialized Treatments in Hamilton, Ontario. She also practices pharmacy at Brant Arts Dispensary in Burlington, Ontario and is the pharmacist representative to the Ontario Rheumatology Association’s Model of Care committee.View Full Bio